Objective <p>Severe acute pancreatitis (SAP) is associated with a relatively high mortality rate. Conventional intensive care unit (ICU) nursing care has limitations in symptom control and complication prevention, and the effectiveness of refined ICU nursing care still requires further empirical validation. Therefore, this study aimed to investigate the application of refined ICU nursing care in patients with SAP.</p> Methods <p>This was a prospective randomized controlled trial. Eighty-four patients with SAP admitted to the ICU of our hospital were randomly assigned to a control group or an observation group using the random number table method. The control group received conventional nursing care (monitoring vital signs, maintaining effective circulation, gastrointestinal decompression, nutritional support, and medication guidance). The observation group received refined ICU nursing care in addition to conventional care. Core measures included: (1) establishing a specialized nursing team with training and formulating individualized care plans based on patients’ conditions; (2) dynamically monitoring vital signs and organ functions and strengthening complication prevention (e.g., preventing pressure ulcers and monitoring excretion); (3) providing disease education via videos and manuals; (4) offering targeted psychological support (sharing successful cases and encouraging family involvement); and (5) implementing staged dietary management (fasting with nutritional support during the acute phase, followed by gradual transition to a normal diet after symptom relief). Data were collected using the Self-Rating Anxiety Scale (SAS), the Self-Rating Depression Scale (SDS), the World Health Organization Quality of Life Assessment Scale (WHOQOL-BREF), as well as blood and urine amylase tests. Data were analyzed using GraphPad Prism 9.0. Independent-samples or paired-samples t-tests were applied for continuous variables, and the χ² test was used for categorical variables.</p> Results <p>The nursing effectiveness rate in the observation group (97.62%) was higher than in the control group (80.95%) (<i>P</i> &lt; 0.05). The observation group exhibited shorter times to symptom resolution (fever, abdominal pain, nausea, vomiting), reduced length of hospital stay, lower blood and urinary amylase levels, lower SAS and SDS scores, and higher WHOQOL-BREF scores across all dimensions (<i>P</i> &lt; 0.05). The overall incidence of complications was lower in the observation group (7.14%) than in the control group (23.81%) (<i>P</i> &lt; 0.05), while patient satisfaction was higher (95.24% vs. 73.81%, <i>P</i> &lt; 0.05). The readmission rate did not differ significantly between the control group (7.14%, 3/42) and the observation group (11.90%, 5/42) (<i>P</i> = 0.713).</p> Conclusion <p>Refined ICU nursing care can shorten symptom resolution time and hospital stay, reduce amylase levels, alleviate negative emotions, lower complication rates, and improve patient satisfaction in SAP patients. However, as this was a single-center study with a relatively small sample size, further confirmation through multi-center, large-sample trials is warranted.</p>